2. ANATOMY
• Also called AUDITORY or PHARYNGOTYMPANIC TUBE
• Connects NASOPHARYNX with TYMPANIC CAVITY
• Bony (1/3) and Fibrocartilagenous (2/3)
• Two parts meet at ISTHUMUS
• Tympanic end is situated in anterior wall of middle ear
• Pharyngeal end is situated in the lateral wall of nasopharynx
behind the posterior end of inferior tubinate
• The cartilage raises an elevation called TORUS TUBARIUS
6. ELASTIN HINGE
• The cartilage, at the junction of medial and lateral lamina at
the roof
• It is rich in elastin fibres
• It helps to keep the tube closed when no longer acted upon by
dilator tube muscle
7. OSTMANN’S PAD OF FAT
• It is a mass of fatty tissues related laterally to the
membranous part of the cartilaginous tube
• It also helps to keep the tube closed
• It protects it from the reflux nasopharyngeal secretions
8. NERVE SUPPLY
• Tympanic branch of the IX (GP) Cranial nerve
• Sensory and parasympathetic secretomotor fibres
• Mandibular branch of Trigeminal nerve
• Tensor Veli palatine
• Pharyngeal Plexus
• Levator vali palatine
• Salpingopharyngeus
9. BLOOD SUPPLY
• Ascending pharyngeal branch
• Branches of the maxillary artery
• Middle meningeal artery
• Venous returns drain into the pterygoid venous plexus
• Lymphatic drain into the retropharyngeal lymph nodes.
10. FUNCTIONS
• Ventilation and thus regulation of middle ear pressure
• Protection
• Nasopharyngeal sound pressure
• Reflux of nasopharyngeal secretions
• Clearance of middle ear secretions
11. INFANT VS ADULT (Q)
INFANT ADULT
Length 13-18 mm 31-38mm (36mm)
Direction More Horizontal (10°) Less Horizontal (45°)
Bony vs Cart. Bony is more Bony (1/3) cart (2/3)
Tubal Cart. Flaccid Rigid
Density of elastin Less More
Ost. Pad of Fat Less in Volume More in Volume
12. ET FUNCTION TESTS
• Valsalva test
• Politzer test
• Catheterization
• Toynbee’s test
• Tympanometry
• Radiological test
• Saccharine or methylene
blue test
• Sonotubometry
13. VALSALVA TEST (Q)
• The principle of this test is to build positive pressure in the nasopharynx
so that air enters the Eustachian tube.
• Steps
• Take a deep breath
• Patient pinches his nose between thumb and index finger
• Close the mouth
• Blow through the ear
• TM is examined through otoscope
• Test to be avoided in
• Presence of atropic scar of TM
• In the presence of infection of nose or nasopharynx
14. POLITZER TEST
• Done in children who are unable to do Valsalva test
• Politzer bag is introduced to the side of the nose to be tested
• Other side of the nose is closed
• The bag is compressed at the same time patient is asked to
swallow
15. TOYNBEE’S TEST
• This maneuver uses negative pressure
• Patients nose is pinched and is asked to swallow
• TM is observed
16. DISORDERS OF ET (Q)
• Tubal blockage
• Adenoids and ET function
• Cleft palate and tubal function
• Down syndrome and tubal function
• Barotrauma
17. ADENOIDS AND ET FUNCTION
• Mechanical obstruction of tubal opening
• Acting as reservoir for pathogenic organisms
• In case of allergy, mast cells of the adenoid tissue release
inflammatory mediators which cause tubal blockage
18. CLEFT PALATE AND TUBAL
FUNCTION
• Abnormalities of torus tubarius
• Tensor veli palatini muscle does not insert into the torus
tubarius in 40% cases
19. DOWNS SYNDROME AND TUBAL
FUNCTION
• Due to poor tone of tensor vali palatini muscle
• Abnormal shape of nasopharynx
20. BAROTRAUMA
• Failure of ET to maintain middle ear pressure at ambient
atmospheric level
• Due rapid descent during air flight, underwater driving or
compression in pressure chamber
21. CAUSES OF ET OBSTRUCTION
• URTI (Viral or Bacterial)
• Allergy
• Sinusitis
• Nasal Polyps
• DNS
• Adenoids
• Nasopharyngeal
tumor/mass
• Submucous cleft palate
• Down syndrome
• Functional
23. SEROUS OTITIS MEDIA
• Secretory otitis media, mucoid otitis media, “Glue Ear”
• Insidious condition characterized by accumulation of non
purulent effusion in middle ear
• Sterile fluid
• Common in school children
25. AETIOLOGY
• Malfunctioning of ET
• Adenoid hyperplasia
• Chronic Rhinitis and Sinusitis
• Chronic Tonsillitis
• Benign and Malignant tumors of nasopharynx
• Palatal defects
• Allergy
• Unresolved otitis media
• Viral infections
26. CLINICAL FEATURES
• Symptoms
• Hearing loss
• Delayed or defective speech
• Mild earaches
• Otoscopic findings
• TM is often dull and opaque due to loss of light reflex
• Appear yellow, grey or bluish
• Thin leash of blood vessels may be seen in TM
29. • Surgical
• Myringotomy and aspiration of fluid
• Grommet insertion
• Tympanometry and cortical mastoidectomy
• Surgical treatment of causative factor
30.
31. RECURENT ACUTE OTITIS
MEDIA
• Infants and children of age between 6M to 6Y
• 4-5 times a year
• Usually due to URTI
• Feeding babies in supine without propping up the head
32. MANAGMENT
• Finding the cause and eliminating
• Antimicrobial prophylaxis
• Myringotomy and insertion of tympanistomy tube
• Child has 4 bouts od acute otitis media in 6 M
• 6 bouts in 1 year
• Adenoidectomy with or without tonsillectomy
• Management of inhalant or food allergy
